Historic Cemetery • Annual Monitoring Form

Please email grants@nullpreservewa.org or call 206-462-2999 if you have any questions.

Historic Cemetery Grants • Annual Monitoring

"*" indicates required fields

Cemetery Name

County

Cemetery Address

Street Address City State ZIP Code

Grant Cycle in which Funds were Awarded

Owner's Name

First Last

Phone

Owner's Mailing Address

Street Address City State ZIP Code

Photo Documentation

REQUIRED. Please submit photos capturing the cemetery and the specific site(s) where grant-funded work occurred. If changes or alterations have been made to the project site(s), include additional images illustrating these changes. Please label photo file names.

Drop files here or

Max. file size: 50 MB.

Describe any changes, alterations, new building/features to the cemetery in the last year.

For example: was a columbarium built or a fence replaced?

If changes have been made, did you contact program staff prior to implementing the changes?*

Yes

N/A (did not make changes)

Describe any damage the cemetery incurred in the last year, noting the cause of damage.

Describe any anticipated changes or projects in upcoming year.

Program staff will request more information if necessary, but it is still your responsibility to contact staff before any significant projects begin that will impact the cemetery within the 10-year maintenance agreement period.

Submission*

I hereby acknowledge that the information provided in this form is complete and accurate.

Today's Date*

49472